07-25-16 Septic Compliance - Laserfiche WebLink

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Property address: 795 Lakeview Parkway Inspector initials/Date: RLP � 07/25/2016 (mMdd/yyyy) 1. Impact on Public Health— Compliance component#1 of 5 Com liance criteria: Verifcation method(s): System discharges sewage to the ❑Yes � No ❑ Searched for surface outlet round surface. ❑ Searched for seeping in yard/backup in home System discharges sewage to drain ❑Yes � No ❑ Excessive ponding in soil system/D-boxes tile or surface waters. ❑ Homeowner testimony(See Comments/Explanation) System causes sewage backup into ❑Yes � No ❑"Black soil"above soil dispersal system dwelling or establishment. ❑ System requires"emergency"pumping Any"yes"answer above indicates the ❑ Performed dye test system is an imminent threat to public ❑ Unable to verify(See Comments/Explanation) health and safety. ❑ Other methods not listed(See Comments/Explanation) Com m ents/Explanati on: New Installation 2. Tank Integrity—Compliance component#2 of 5 Com liance criteria: Verification method(s): System consists of a seepage pit, ❑Yes � No ❑ Probed tank(s)bottom cesspool,drywell, or leaching pit. ❑ Examined construction records Seepage pits meeting 7080.2550 may be ❑ Examined Tank Integrity Form(Attach) com liant if allowed in local ordinance. Sewage tank(s) leak below their ❑Yes � No �Observed liquid level below operating depth designed operating depth. ❑ Examined empty(pumped)tanks(s) If yes,which sewage tank(s) leaks: ❑ Probed outside tank(s)for"black soil" Any "yes"answer above indicates the ❑ Unable to verify(See Comments/Explanation) system is failing to protect groundwater. ❑Other methods not listed(See Comments/Explanation) Com ments/Explanation: New Installation 3. Othel'COmpl1d11Ce C011d1t10115—Compliance component#3 of 5 a. Maintenance hole covers are damaged,cracked,unsecured,or appear to be structurally unsound. ❑Yes* �No ❑Unknown b. Other issues(elechical hazards,etc.)to immediately and adversely impact public health or safety. ❑Yes* �No ❑Unknown *System is an imminent threat to public hea/th and safety. Explain: c. System is non-protective of ground water for other oonditions as detertnined by inspector. ❑Yes* �No *System is failing to protect groundwater. Explain: www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Available in altemative formats wq-wwists4-316 • 6/4/14 Poge 2 of 3